Abstract
Background: We aim to analyze incidence and outcomes of patients hospitalized with hospital-acquired pneumonia (HAP) according to chronic obstructive pulmonary disease (COPD) status and sex in Spain (2016–2019). Methods: We conducted a retrospective cohort study using national hospital discharge data of patients ≥40 years with a primary diagnosis of HAP, using the specific diagnostics of non-ventilator (NV)-HAP and ventilator-associated pneumonia (VAP). Results: We identified 37,029 patients with HAP ((NV)-HAP 87.28%, VAP 12.72%), 13.40% with COPD. HAP incidence increased over time, but only in subjects without COPD (p < 0.001). In women, incidence of HAP and (NV)-HAP was similar regardless of COPD status, but VAP incidence was lower in COPD women (p = 0.007). In men, the incidence of (NV)-HAP was significantly higher in those with COPD, while VAP incidence was lower in COPD men (p < 0.001). The in-hospital mortality (IHM) was similar in men and women with and without COPD. The risk of dying in hospital increased with age, congestive heart failure, cancer, and dialysis among men and women with COPD. Men that underwent surgery had a lower risk of IHM. VAP increased 2.58-times the probability of dying in men and women. Finally, sex was not associated with IHM among COPD patients. Conclusions: Incidence of HAP was significantly higher in COPD patients than in those without COPD, at the expense of (NV)-HAP but not of VAP. When stratifying by sex, we found that the difference was caused by men. IHM was similar in COPD and non-COPD patients, with no significant change overtime. In addition, sex was not associated with IHM.
Highlights
Hospital-acquired pneumonia (HAP) is a severe nosocomial infection that affects many hospitalized patients and is associated with increased morbidity, mortality, and health costs [1]
A total of 37,029 patients (65.39% men and 34.61% women) aged ≥40 years were hospitalized with a diagnosis of hospital-acquired pneumonia (HAP) in Spain during the period 2016–2019. (NV)-HAP diagnosis was identified in 32,319 patients (87.28%) and ventilator-associated pneumonia (VAP) diagnosis in 4710 patients (12.72%)
We have found that the incidence of HAP only increased in subjects without chronic obstructive pulmonary disease (COPD) (250 cases per 100,000 hospitalized subjects without COPD in 2016 to 288 in 2019; p < 0.001), both in those with (NV)-HAP (217 in 2016 to 246 in 2019; p < 0.001) and those with VAP (33 in 2016 to 42 in 2019; p < 0.001)
Summary
Hospital-acquired pneumonia (HAP) is a severe nosocomial infection that affects many hospitalized patients and is associated with increased morbidity, mortality, and health costs [1]. Most epidemiologic and etiologic studies in this field have been focused on critically ill patients [2] In this regard, ventilator-associated pneumonia (VAP) is a subgroup of HAP that occurs in mechanically ventilated patients more than 48 h after tracheal intubation [3]. Both (NV)-HAP and VAP cause considerable clinical and economic burdens, most of the published studies focuses primarily on VAP [4] This is probably the result of the greater severity of this disease in patients in the intensive care unit (ICU) setting, as well as the ability to more precisely define the presence of true infection in mechanically ventilated patients with pneumonia using diagnostic techniques such as bronchoalveolar lavage (BAL) with quantitative cultures [5].
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